Estrogen Question Gets Tougher

Published: April 6, 2000

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Dr. Nanette Wenger, a cardiologist at Emory University, said she went to a medical meeting recently and tried to explain the questions about hormone replacement therapy and heart disease to an audience of about 700 obstetricians and gynecologists. They were surprised, she said, telling her that they had thought that it was well known that estrogen prevented heart disease. As a result, Dr. Wenger said, ''often coronary disease is cited as the reason to prefer estrogen over other therapies.''

Some gynecologists say they will continue, for the time being, to recommend that some women take estrogen to protect against heart disease. Dr. Wulf H. Utian, an obstetrician/gynecologist in Cleveland who is the executive director of the North American Menopause Society, said he had and still would use estrogen for that purpose. The new findings, he said, ''don't change my stance at all.''

Dr. Charles B. Hammond, a professor and chairman of the department of obstetrics and gynecology at Duke University, said ''it's way too soon to react'' to the Women's Health Initiative study. Hormone replacement therapy ''is one tool in the war on cardiovascular disease and a very important one,'' he said, cautioning that at this point ''we have to be very careful not to stampede women based on scanty information.''

But some women say their doctors tried to stampede them the other way -- into taking the hormones.

''My experience was plain and simple,'' said Alice Wolfson, a 55-year-old lawyer in San Francisco. Although she has no risk factors for heart disease, she said, her doctor urged her to take the therapy to protect her heart. ''My doctor said, 'You should be taking hormone replacement therapy,' '' she recalled.

Sarah Grindel, 59, who runs a quilting business with her daughter in Rockport, Mass., saw three doctors, all of whom insisted that she should take estrogen to protect against heart disease, even though her blood pressure is low, her cholesterol level is fine and she has no family history of heart disease. ''Every doctor was saying just do it, do it,'' she said.

Dr. Wenger, a principal investigator in the Women's Health Initiative Study, said yesterday that her office had been inundated with calls from other doctors. ''My phone has been ringing off the hook from my colleagues,'' she said. ''Should I let my wife take estrogen? Should my wife continue with estrogen?''

''The answer is that right now, we don't know,'' Dr. Wenger said. That is why the National Institutes of Health is doing its study.